160 Armand-Majeau Sud

Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0

T.+1-866-650-6555 F. +1-888-966-6555

orders@motioncomposites.comwww.motioncomposites.com

MOVEORDER FORM - AADL # W114

P.O. number:* Date: Ship to:*

Company Name:* Phone:* Name:

Ordered by:* Address:

Clinician City: Prov:

Email: Postal Code:

Marked for: Phone:

* Required

MODEL

1 MVWC01 Ultralight MOVE wheelchair aluminum. (265 lb weight capacity) $1 395 □

2 MVWC09 Heavy duty kit (350 lb weight capacity) $775 □

SEAT WIDTH 3

3 MVSW14 Seat width: 14" □ 15" □ 16" □ 17" □ 18" 1 □

19" 1 □

NC □

4 MVSW20 Seat width: 20" 1 □ 22" 2 □ $295 □

SEAT DEPTH

5 MVSD16 Seat depth: 16" □ 18" □ NC □

6 MVSD20 Seat depth: 20" □ $225 □1 - Available with HD option 2 - Only available with HD option 3. Width calculator

STD +1" +2" STD +1" +2" STD +1" +2" STD +1" +2" STD +1" +2"

P1 12 1/2 13 1/2 14 1/2

P2 13 14 15 13 1/2 14 1/2 15 1/2

P1

P2 13 14 15 13 1/2 14 1/2 15 1/2

P3 13 1/2 14 1/2 15 1/2 14 15 16 14 1/2 15 1/2 16 1/2

P4 14 15 16 14 1/2 15 1/2 16 1/2 15 16 17 15 1/2 16 1/2 17 1/2

P1 15 1/2 16 1/2 17 1/2 16 17 18

P2 15 1/2 16 1/2 17 1/2 16 17 18 16 1/2 17 1/2 18 1/2

P3 16 17 18 16 1/2 17 1/2 18 1/2 17 18 19 17 1/2 18 1/2 19 1/2

P4 16 17 18 16 1/2 17 1/2 18 1/2 17 18 19 17 1/2 18 1/2 19 1/2 18 19 20

P5 16 1/2 17 1/2 18 1/2 17 18 19 17 1/2 18 1/2 19 1/2 18 19 20 18 1/2 19 1/2 20 1/2

Height available +- 1/4" (see stem bolt and fork combination at the end of the order form)

Move FRONT Seat-to-floor Height - Please select your choice4" caster 5" caster 6" caster 7" caster 8" caster

Stem bolt length Stem bolt length Stem bolt length Stem bolt length Stem bolt length

Fork/Position

4"

5"

7"

5.0

MVMA080 □English Manual (STD)

MVMA081 □Manuel Français

Taxes not included

Motion CompositesT.450 588-6555 1 866 650-6555 F.450 588-0200 MOVE AADL CAN 4.8 V2.xlsx October 1st, 2019 1 of 5

CASTERS

7 MVCA01 Composite wheel w/ PU tire (1" width) 4" □ 5" □ 6" □ 7" □ 8" □ NC □

8 MVCA10 Pneumatic 6" x 1 ¼" $160 □

9 MVCA11 Pneumatic 8" x 1 ¼" $160 □

10 MVCA14 4" x 1 ½ " $98 □

11 MVCA15 5" x 1 ½ " $98 □

12 MVCA16 6" x 1 ½ " $98 □

13 MVCA17 4" x 1 ½" $175 □

14 MVCA18 5" x 1 ½" $185 □

15 MVCA19 6" x 1 ½" $195 □

Move REAR Seat-to-floor Height - Please circle your choice

Note: Tire size, center of gravity setting and seat slope may result in a variation of +/- ½” of selected seat to floor height"

SWING-AWAY FOOTREST

16 MVFR01 60° swing away footrest See line 18 ( 5 - 13.5") □ 13.5 - 17.5" □ 15.5 - 19.5" □ 17 - 21" □ $250 □

17 MVFR02 70° swing away footrest See line 18 ( 5 - 13.5") □ 13.5 - 17.5" □ 15.5 - 19.5" □ 17 - 21" □ $250 □

FOOTREST OPTIONS

18 MVFR09 High mount (footplate attached tothe hanger with clamps) Range: 5 - 13.5" $90 □

* +/- 1/2"

ELEVATING LEGREST (unit) The elevating legrest replace the footrest side selected

19 MVFR10 Elevating legrest with calf pad, 14” - 19” Length adjustable Left □ Right □ $390 □

FOOTPLATES

20 MVFP01 STD □

21 MVFP02 Newton adjustable angle - Composite $145 □

22 MVFP03 $165 □

23 MVFP08 Length adjustable heel loop $25 □

24 MVFP09 Calf strap $52 □

25 MVFR23 Swing away residual limb support - 7" x 9" Left □ Right □ $390 □

26 MVFR12 Swing away residual limb support - 8" x 11" Left □ Right □ $390 □

27 MVBC01 8° bend aluminum back cane 16" □ 18" □ 20" □ STD NC □

ADJUSTABLE ANGLE BACK

28 MVBC02 8° bend aluminum back cane 16" □ 20" □ STD $209 □

29 90° □ 95° STD □ 100° □ 105° □ 110° □

30 MVPH04 Stroller handle (not available with the HD option) $210 □

31 MVPH03 Folding stabilizer bar $258 □ 1 - Stroller handle and stabilizer bar can't be combined

*A1 - Client responsibility; A2- Clinical justification

A1*

A1*

A1*

A2*

A2*

13 "

Newton UltraCaster Soft-Roll Composite

Set at:*

Newton adjustable angle - Aluminum

17"

19"

14"

15"

17"

14"

14"

20" 22" 24"

Newton UltraCaster Soft-Roll Aluminum

15"

12 " 13"

15"

16"

18"

A1*

FOOTPLATE ACCESSORIES

16"

A2*

A2*

Set at:*

RESIDUAL LIMB SUPPORT (Height and angle adjustable) (unit)

Set at:*

Back canes with integrated fixed height push handle FIXED ANGLE BACK

STROLLER HANDLE AND STABILIZER BAR 1

Select back cane angle:

Standard - Composite

A1*

17" 18"

Set at:

16"

A2*

Motion CompositesT.450 588-6555 1 866 650-6555 F.450 588-0200 MOVE AADL CAN 4.8 V2.xlsx October 1st, 2019 2 of 5

BACK UPHOLSTERY

32 MVBH05 Slip-on Nylon back upholstery NC □

33 MVBH06 Adjustable tension Nylon back upholstery $175 □

34 MVBH99 Omit back upholstery STD □

SEAT CUSHIONS

35 MVSC99 STD

ONE ARM DRIVE 1 Only available with Newton One rear wheels with Aluminum, Plastic coated Handrims

36 MVHR22 One arm drive 2 24" left □ right □ $1 395 □

37 MVHR98 Omit handrim on opposite side of the One Arm Drive (OAD) NC □

REAR WHEELS

38 MVRW01 Mag 1 20" □ 22" □ 24" □ NC □

39 MVRW02 Newton One - spoke wheel 2 20" □ 22" □ 24" □ NC □

40 MVRW03 Newton Gravity - ultralight wheel 20" □ 22" □ 24" □ $360 □ 1 - HP tires are not compatible with Mag Wheels -use only aluminum or plastic coated handrim 2- Not compatible with Shox tires

TIRES

41 MVTI01 Soft Urethane 1 1/4 " STD □

42 MVTI02 Soft Urethane knobby 1 3/8 " $130 □

43 MVTI04 Soft Urethane - Shox 1" $155 □

44 MVTI05 Pneumatic 1 3/8 " $130 □

45 MVTI08 Pneumatic with Airless insert 1 3/8" $215 □

46 MVTI06 Pneumatic HP - 1" $150 □

47 MVTI07 Pneumatic HP - Schwalbe Marathon Plus 1'' $230 □

HANDRIM

48 MVHR01 STD □

49 MVHR07 Newton Air Grip1 Noir $150 □

Assembly position for aluminum and Newton AirGrip handrims

50 MVHR29 Standard Handrim position Full tab STD □

51 MVHR30 Narrow Handrim position Short tab 2 positions $25 □

52 MVHR31 Super Narrow Handrim Short tab 2 positions STD □ Short tab 1 position □ $25 □

HANDRIM

53 MVHR02 $160 □

54 MVHR99 NC □1- Not available with Mag wheels 2 - Not available in 20" 3- Only standard handrim position available

AXLES (0° camber)

55 MVAX01 Quick release axle STD □

56 MVAX02 Permanent axle NC □

57 MVAX03 Quad release axle $170 □

AXLE PLATE

58 MVAX04 Amputee adjustable axle plate 1 $250 □ 1 - May limit seat to floor height available

*A1 - Client responsibility; A2- Clinical justification

A1*

Omit seat cushion

Available

20", 22" 24"

22", 24"

22", 24"

20", 22", 24"

22", 24"

20", 22", 24"

A2*

A2*

24"

Plastic coated 3

Aluminum anodized

Omit handrim

Motion CompositesT.450 588-6555 1 866 650-6555 F.450 588-0200 MOVE AADL CAN 4.8 V2.xlsx October 1st, 2019 3 of 5

Product improved

1- Offered with handrims on each side of the wheelchair 2- Only standard handrim position available 2- Only standard handrim position available

Choose position of rear wheel axle plate:

Measure distance from front of back post to center of axle receiver.

Default setting is at 3/4"Most stable Most responsive

AMPUTEE 3/4" 2"

□ □ □

WHEEL LOCKS

59 MVWL08 Newton Wheel lock - push to lock STD □

60 MVWL02 Pull to lock NC □

61 MVWL04 Newton grade aid push to lock (suggested with pneumatic or high pressure tire) $175 □

62MVWL13

MVWL14 6" removable extension handle $67 □

63 MVWL06 $230 □

64 MVWL99 NC □

FLIP BACK ARMREST (Convertible to "T" armrest) 1 Height Adjustment

65 MVAR01 10" Desk length arm pad 8 - 12" STD □ 10 - 14" □ $380 □

66 MVAR02 14" Full length arm pad 8 - 12" STD □ 10 - 14" □ $380 □

"T" ARMREST 1 Height Adjustment

67 MVAR03 8 - 12" STD □ 10 - 14" □ $360 □

68 MVAR04 8 - 12" STD □ 10 - 14" □ $360 □

1 - May have a 1/2 " adjustment restriction on both limits of the range

GEL ARM PAD

69 MVAR12 14'' Full Length Arm Pad - Gel Ovation $150 □

70 MVAR99 NC □

POSITIONING BELTS

71 MVSB07 Hardware attachment for 2 point seatbelt (1 pair) NC □

72 MVSB03 $13 □

73 MVSB99 Omit positioning belt STD

*A1 - Client responsibility; A2- Clinical justification

CENTER OF GRAVITY

A2*

Locked □ Unlocked □ STD

Additional hardware for 2 extra attachment points (needed for the 4 point seat belt) (1 pair)

Attendant Lock (additional set of wheel lock mounted to the back)

10" Desk length arm pad

Removable function

Omit wheel locks

A1*

14" Full length arm pad

Omit armrest

Locked □ Unlocked □ STD

A1*

A2*

Motion CompositesT.450 588-6555 1 866 650-6555 F.450 588-0200 MOVE AADL CAN 4.8 V2.xlsx October 1st, 2019 4 of 5

ACCESSORIES

74 MVAC03 Anti tippers $115 □

75 MVAC27 Tip assist 1 $60 □

76 MVAC04 Transit Tie Down (Unoccupied) NC □

77 MVAC06 Cane carrier Left □ Right □ $105 □

78 MVAC08 Spoke guards 3 Available: 20", 22", 24" $145 □

79 MVAC09 Footrest neoprene impact guard (pair) - Black $80 □

80 MVAC10 Seat pouch $95 □

81 MVAC26 BodyPoint Mobility Bag $135 □

82 MVAC23 Newton Backpack $120 □

83 MVAC12 Velcro Closing Strap $50 □

84 MVAC13 Tool kit $50 □

1 - Cannot be combined with Anti Tippers 2 - May interfere with swing away armrest ; Not available with HD option 3 - Not available with Mag wheels

85 MVFC01 Black STD

*A1 - Client responsibility; A2- Clinical justification

Notes :REFERENCE PAGE 12 OF THE AADL WHEELCHAIR APL FOR OPTIONS AND CATALOGUE NUMBERS FOR CATEGORY "A" WHEECHAIRS SEATBELTS & OXYGEN TANK HOLDER: VENDOR TO USE AADL GENERIC PARTS PRICING & SUPPLIER

A1*

A1*

A1*

Fork and Stem bolt combinations

FRAME COLOR (with black aluminum crossbrace)

TOTAL

A1*

A1*

A1*

A1*

Motion CompositesT.450 588-6555 1 866 650-6555 F.450 588-0200 MOVE AADL CAN 4.8 V2.xlsx October 1st, 2019 5 of 5